Interpretation of chest radiographs from children with lower respiratory tract infections

Introduction: Pneumonia is a common diagnosis amongst children admitted to hospital. Diagnosis relies upon accurate chest radiograph interpretation. This study compared levels of agreement amongst paediatric clinicians and consultant paediatric radiologists when interpreting CXRs. Methods: Four paediatric radiologists, independently interpreted 5 radiological features (and no features) for each of 30 CXRs, randomly selected from 100 radiographs attained over two years from children with fever & signs of respiratory distress aged 6 months to 16 years. The same CXRs were then interpreted by 21 other paediatricians with varying experience level. Agreement split by grade and specialty, was analysed using free-marginal multirater Kappa, assuming no prior expectation of the proportion of radiographs with each feature. Conclusion: Paediatric radiologists showed high levels of agreement for all features. Normal CXRs and pleural effusions were identified consistently amongst all 25 clinicians. However, interpretation of all other features had lower levels of agreement within non paediatric radiologists. This highlights the need for more rigid training in interpreting CXRs for paediatricians and the early reporting of CXRs by paediatric radiologists.